Monday, June 14, 2010

Choosing and getting into MPH programs: Part 2: What is a Master's in Public Health, anyway?

This is Part 2 in my series about choosing and getting into (and funded by!) MPH programs. Read Part 1 here.

I thought that before really launching into this discussion, I should discuss a little bit more about the field of public health and why you would even get an MPH.

"So, what is an MPH? Do you like, work in a hospital then?"

On behalf of all MPH students everywhere, let me ask everyone, everywhere, one huge favor: don't ask us "What do you do with that? Like, work in a hospital?" As my fellow MPH-er put it recently, hospitals are not public health; they are where you go when public health has failed. (Of course I'm only confusing those people more now by going to work in a hospital - but that's with my clinical lactation consultant training, not with my MPH.)

I think this question does nicely illustrate how most people seem to equate "health" with "medicine", without stopping to think about the huge array of social and environmental factors that impact health and disease. On the other hand, if you are one of the people who does stop to think about that, you may be ready for a career in public health!

So what IS public health? The American Schools of Public Health have decided to answer this with a "This is Public Health" sticker campaign Their website and video will give you a pretty good overview. But just as a summary:

- Public health deals with populations, rather than individuals

- So public health professionals tend to work on programs, policies, administration, and research - not with personally delivering services to individuals

- Public health focuses much more on prevention than on treatment

To get an idea of what kinds of jobs people get with an MPH, you can take a look at Johns Hopkins' archived list of job postings (note that some require more than an MPH), or look at the American School of Public Health's careers page (and explore their website in general.)

The ASPH career page also has descriptions of various fields in public health, e.g. epidemiology, environmental health, biostatistics, maternal and child health, health education, etc. While small MPH programs will have just one or two general tracks, most schools of public health will have many departments encompassing various fields of public health. An MPH, even within the same school, can mean a very different set of skills and very different focus depending on what department you study in. I'll discuss this more in the next post on researching schools and programs.

I can't speak to all programs, particularly more technical ones, but I think I can safely say most MPH programs generally aim to equip you with a good understanding of how diseases and health conditions occur on a population level. Other focuses can be on how to administer public health programs (e.g. a vaccination campaign) and how to monitor and evaluate those programs (e.g., devise a plan to make sure that the vaccination campaign is reaching the populations it was targeting, and then assess whether it made a difference on vaccination rates in those populations, and whether the difference was big enough to justify spending all that time and money). They may also cover particular content areas (e.g. courses on epidemiology of infectious diseases, or an overview of HIV globally) or skills (e.g. advanced statistical modeling techniques).

A master's in public health is more practice-oriented than research oriented (versus a doctoral degree in public health) - generally considered a "professional degree" like, for example, a master's in social work. While some people in an MPH program may be there as a stepping-stone to a doctoral degree, most are there to go right back out into the workforce. So a master's program generally will have less emphasis on research and more on practice. This isn't to say that MPH grads don't go on to do research, but they also go on to do a huge range of other types of work.

A note about the nature of the MPH degree and exactly what the practice is that you do with it: One thing I struggle with personally is the pull between direct service delivery (which I looove doing) and the desire to make a bigger impact - which is why I tend to run out of steam with direct service delivery after a while. I start seeing how it all fits into a bigger picture and what needs to happen to prevent problems or deliver services more efficiently.

Yet while an MPH is very well suited to the big-picture work, as my classmates take positions in research fellowships, evaluation of programs, or doing technical assistance on grants, I find myself resisting taking anything that would put me in front of a computer all day, with several layers of people between me and the programs on the ground. Back and forth, back and forth! Right now I'm looking for something with more of a mix between the two, and those jobs do exist - but just remember, by its nature a public health job deals with populations, not individuals. If you thrive on the personal contact with the people you serve, you might want to consider a clinical degree instead or in addition. (I know I'm very glad to be working on my IBCLC right now.)

In the next post, I'll talk about how to sort through different MPH programs and think about which is the right fit for you.

Wednesday, June 9, 2010

Two great "how-to-breastfeed" videos

I love this breastfeeding video! I know approx. everyone on the birth blogs has posted it (I first saw it on Gloria Lemay's blog). But just in case you haven't seen it:



Things I love:

- Obviously, skin-to-skin and breastfeeding right after c-section - wouldn't that be a great instructional video for medical staff?

- Simple, calm, and clear discussion (with that cute Norwegian accent!)

- Showing that it takes a new baby a little while to latch, and what can be accomplished with patience

- Showing a good latch and how to get it, including a really nice illustration of how to compress/"sandwich" the breast - it is surprising how hard it is to get this concept across sometimes

- There's even a great demo of tongue-tie - and wow, was that baby ever a classic tongue-tie.

Along with Rixa, I would love to see the 45-minute version.

If you're looking for another good, short instructional video online, I like this one from Ameda:



(You can also find it posted on Ameda's website here.)

Things I love:

- Again, simple and clear

- Explanation of why a deep latch is important and showing exactly what's going on in a baby's mouth when it breastfeeds - so helpful!

- Suggestions for gently getting baby ready and alert to start breastfeeding

The LCs I have been working with sometimes show this video on the computer in the postpartum room. I think it would be even better if we had a smartphone or iPod touch so we could have it handheld right by mom's bedside (the computer is often across the room in an awkward corner). Think I can convince the hospital to buy us one??

With both of these videos, I will say I wish they were more diverse. The Norwegian one - OK, I get having a lot of white people. But I think Ameda could and should have done a better job of including moms and babies of color.

Wednesday, June 2, 2010

Choosing and getting into MPH programs: Part 1: Should you even get an MPH?

This is Part 1 in my series about choosing and getting into (and funded by!) MPH programs.

Let me start by saying something in general about master's programs. I have a fairly task-oriented view to master's programs, which is that they should serve a specific purpose in your life and you should feel fairly confident about what that purpose is.

It makes me nervous when someone talks about having found a master's program in "EXACTLY what I want to do". This is often preceded by someone explaining to me that they love swimming, and they are really into crafts, and they have just been wanting to take this interest farther, and come to find out they have just heard about a master's in underwater basket weaving (MUBW)!! Isn't that PERFECT?

And then I get a little bit cringe-y. Because yes, while you can have a fun 2-ish years doing exactly what you want to do, you then need to get a job. Do I love doing breastfeeding work? Yes, I made it a huge focus of my MPH degree. Would I rather have gotten a master's in lactation studies instead of an MPH? Honestly, no. I might have a super fun 2 years thinking and talking about my exact interests, but then I have to find a job. The breastfeeding promotion programs out there are probably going to be looking for an RN, RD, MPH, or MSW. And while they may be happy to hire someone with a master's in lactation studies, they're the only ones: that degree isn't going to have a lot of portability if the only jobs I can find are in HIV prevention or monitoring a heart disease reduction program. Those jobs may not be exactly what I want, but life doesn't always give you exactly what you want; it's good to spend the time and money on something that is adaptable.

This may be a cynical view, but schools need money and a master's program is a way to get it. They don’t have to worry about your long-term marketability. Just because you CAN get a degree in something, doesn't mean you SHOULD.

And that applies not just to the MUBW degrees of the world, but also to these more generalized degrees. Just because you're interested in public health doesn't mean an MPH is right for you. You may be happier and better suited to come at the public health issues you're interested in from a clinical approach, a legal background, or a social work degree (and all of those are also programs which often offer dual degrees with an MPH, for what it's worth). One of those may offer better fallback options for your interests and skills than the MPH, if your dream jobs aren't opening up.

While having a fairly accurate idea of what kind of job you want to do is of course not a prerequisite (thank god for those of us who are indecisive) it can be very helpful. I was talking with a friend the other day who talked about working backwards from the jobs he wanted to the kinds of degrees that people in those jobs held. While the MUBW might seem attractive at first, you may discover that all the underwater basket-weavers have degrees in hydroengineering, or that they all came up through an apprentice system. Jobs in public health are likewise filled with people from a huge range of backgrounds, including biology, engineering, economics, midwifery, nursing, medicine, etc. The jobs you’re interested in may be in public health, but need another type of degree, either instead or in addition to a public health degree.

You can also work forward from the degree and see what kinds of jobs the people who get it tend to do. Keep in mind that by no means are you limited to those fields, but that if you hate the sound of all of them, they are probably not going to be great as your “fallback” jobs if what you really want doesn’t pan out at first.

If you aren’t really sure what you want to do, I’d sit down and ask yourself again why you want to go to graduate school right now. Again, grad school = means to an end. If you have unlimited time and money, get all the degrees you want! But otherwise, know why you’re going to grad school and what you’re planning to get out of it.

All this is less about an MPH in particular, and more about advanced degree programs in general, but I know a few too many people who have done Perfect Degree X and then been shaken by the realization that there are a) no jobs in that field, b) no jobs in that field that they like, c) no jobs they like that they are newly qualified for, d) that they had no idea what the jobs in that field actually were like in the first place, or e) all of the above. (You’ll find doctors completing their residencies who confront (b) and/or (d), which with hundreds of thousands of dollars in debt truly sucks.) So before anyone runs out to get an MPH, I had to do a disclaimer post: just because you can get in doesn’t mean you should do it! Don’t e-mail me in three years wondering why you wasted your time on an MPH when you should have gotten an MUBW! Think hard about it first. All this self-reflection will help you pick the right MPH program if that's what you end up deciding that you want to do.

Edited, June 2011: Many doulas and other birth worker-type people ask me if they should get an MPH. The attraction is pretty strong for us types! We see the system issues, and where the research needs to happen, we are often committed to working with underserved populations, we want to be in a place to make changes on a big scale. But I also see the tension for those same people (myself included) once they enter the field and realize just how far removed most public health is from direct service. If you thrive on personal interaction with the population you serve, there are positions for MPH grads that can fulfill those needs, but they are not in the majority. I find many of those direct-service-oriented people (again, myself included!) contemplating after they graduate whether they need both an MPH and a clinical degree to really get the right mix for themselves. Considering an MPH plus some kind of clinical degree (e.g. RN, CNM, MD, MSW/LCSW) may be a good option and there are many schools that offer dual degree programs. I say this, again, not to discourage anyone from getting an MPH but to really think about what is worth the investment of your time and money.

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Next in the series, I promise to actually talk about masters in public health programs and how to get into them…

Friday, May 28, 2010

Wednesday, May 26, 2010

Public Health Doula, MPH

Family and friends and celebrations have come and gone, graduation is over, and I can now say that I officially have a Master's of Public Health!

To be honest, it feels a bit anti-climactic - my last semester was busy, but mostly with things besides academic work, particularly once my thesis was done at the beginning of April. Unlike the end of my undergrad degree, which was a relieved crossing-the-finish-line feeling, my graduate commencement was more of a "oh, hi finish line, I knew you'd be around here somewhere" feeling.

Still, I am happy and proud of my shiny new graduate degree, and I'm hoping to put it to good use in the near future...whatever form that takes. In the meantime, I want to take a moment to appreciate how much writing this blog, and reading/connecting with other blogs has been an amazing education in and of itself over the past two years. It's filled in some of the spaces a public health education doesn't address, when it comes to my own particular interests. I've learned how to monitor the heck out of a program in my MPH education, but I didn't have many opportunities to debate the nature of informed consent, hear stories from women who felt judged for formula feeding, or gauge how public health recommendations look to, and are interpreted by, the outside world.

I've also valued the opportunity to connect with like-minded people around the country and around the world. The issues of sex, reproduction, reproductive health, abortion, pregnancy, birth, breastfeeding, our agency as women over our own bodies...these are complex issues with many layers of thinking and learning to work through as we talk about them. Sometimes it feels frustrating to feel like you're starting over at "101" level every time you try to discuss them with someone new. I have been so lucky to find people who are already thinking about these issues and their interconnections, and can not just meet me where I'm at but push me further.

It's also deeply enriched my doula practice. I learn about new topics, techniques, research, and ways of thinking about and conveying information to others. More and more frequently, I find myself referring clients and friends to blogs and to blog posts for questions like understanding rising c-section rates or writing a birth plan. Sometimes I think the blog world should be required reading for new doulas (and other birth professionals!) It expands my worldview beyond what I just learn/hear in my training or from other people locally, and helps me contextualize doula practice in the bigger picture of birth issues and activism.

Finally, I have loved building a small but growing community of readers for my blog. Posting about wondering where to find doula clients and having so many wonderful and generous suggestions was such a help for me, and a boost to my confidence. I am so grateful to all of you who commented on that post, and to all of the readers and commenters out there!

I'm not sure what's next for me as a doula and a newly-minted MPH, but I'm excited to be starting work half-time next week at the hospital where I've been training to be an LC. They are hiring me temporarily as a "breastfeeding specialist" (since I'm not an LC yet), to do several night shifts of lactation support a week. This will be my first experience doing lactation support in the hospital solo, not to mention my first experience working nights (well, I've stayed up many nights as a doula but this seems a bit different!) I am excited and of course at least a little nervous, and interested to see where this leads.

I'm also not sure what's next for this blog - between graduation and traveling, it seems to be that just like last year, May has been a vacation month from blogging! And while it always seems like there are a dozen posts or news items a day popping up in my blog reader or news alerts that I could link to and talk about, it's seemed harder recently to actually get those into the blog. With a shift in my work and to some extent my focus, my posts may change too - more? less? different topics? We'll see!

I do plan to do a post soon on applying to and choosing an MPH program, since I have had several e-mails about that from readers and I would really like to help people understand more about the degree, what it can do for you, and what you should be thinking about when applying. As always, I am open to other requests for topics! Just comment, or e-mail, and let me know.

In the meantime, I hope you'll keep reading, and commenting, and linking, and e-mailing! Every time I check my subscriber stats, I do a little happy dance that more people are interested in what I have to say (because as anyone who knows me will tell you, I love to talk) and I hope that community keeps growing.

Friday, May 7, 2010

Why would you show breastfeeding if you're going to talk about babies?

"Babies" is being released this Sunday!. I'm really looking forward to seeing it, hopefully with some of my MCH buddies, but I also had to note this little fact that one of them pointed out. According to the MPAA:

"'Babies' is rated PG (Parental Guidance suggested). Breast feeding."

Yes, the movie "Babies" is PG only - only - because it depicts breastfeeding.

The mind boggles.

Sunday, May 2, 2010

How do/did you look for a doula?

Graduation is quickly approaching - my master's thesis is completed, my classes are thisclose to finished, and soon, I'll be a real, live Master of Public Health (a master! doesn't that sound great?) Time to look for a job, right?

Well, timing is creating a bit of a wrinkle for me. While I'll have my MPH in May, the exam to become an International Board Certified Lactation Consultant (IBCLC) doesn't happen until July. And then it's another wait for the results. I'd like to be able to use that credential in my job search. So I'm hesitant to get desperate and commit to some job, any job, right away. All my job ponderings are another post for another day, but for now I'll say that I'm willing and able to hold out for a couple of months at least before committing to something full-time, long-term, in hopes that what I eventually commit to is up my alley (perinatal issues).

That of course does not mean that I won't be working; instead it means that I need to find more short-term and/or part-time work (a situation with which I am depressingly familiar, but yet again another post for another day). Right now, I'm lining up work to teach a prenatal breastfeeding class, possibly continue doing research assistant work for the department, and looking for more ways to bridge the gap - including trying to work as a private doula again.

I have some real blocks about looking for private doula work (did I mention something about other posts for other days?) but I'm trying to move past them and push myself to do some real marketing. I have an extremely basic website up. I have built a nice little group of local references from families I've worked with as a volunteer. I am getting networked with one of the local CBEs. But every time I sit down to make a flyer or brochure, I get stuck. I think "Will anyone really read this? Am I spending a lot of money at Kinko's and time putting these up, for nothing? Do I need to do more targeted marketing? Where, and how can I not look pushy and obnoxious doing this?" (did I mention something about blocks?)

So I am asking you - maybe you used a doula, or are looking for one now. How did you find that person? What were other ways you used to look for one? What ways did you trust the most? Was there anything you really liked, or that really turned you off?

I may be the only doula in the world who has been to close to 50 births and has never learned how to self-market! But, here I am, and I will appreciate it so much if you have an idea or experience you'd be willing to share.